Trevor Spratt

The impact of adversity in childhood on outcomes in adulthood: research lessons and limitations

• Summary: Current UK Government policy is concerned with the possible connections between childhood adversity, social exclusion and negative outcomes in adulthood. Understanding the impact of adverse childhood experiences on outcomes in adulthood is therefore key to informing effective policy and practice. In this article, the research on the impact of childhood adversity on outcomes in adulthood is reviewed in the broad categories of: mental health and social functioning; physical health; offending; service use; and economic impact. The literature on resilience that focuses on those who experience adversity, but do not have associated negative outcomes is also briefly considered. The strengths and limitations of the range of research methods used are then examined. • Findings: Previous studies have tended to focus on specific forms of adversity, predominantly abuse and neglect, and either: specific populations and specific outcomes; specific populations and general outcomes; or general populations and specific outcomes. This means there may be incomplete understanding of the inputs (the range of adverse experiences in childhood), the processes (how these may affect people) and the outcomes (across domains in adulthood). • Applications : It is concluded that it is important for social work researchers to engage in the current debate about how to prevent harmful childhood adversity and there is an important gap in the research for more interdisciplinary large-scale general population studies that consider the full range of childhood adversity and associated impacts across time and the possible processes involved.

Families with multiple problems: Some challenges in identifying and providing services to those experiencing adversities across the life course

• Summary: A concern amongst policy-makers to identify high cost and low productivity populations has created a new interest in identifying those who experience adversities across the life course. This article outlines the development of conceptual understandings of families whose children experience multiple adversities and links this with later poor outcomes in adult life and examines some of the research challenges in establishing such linkages. • Findings: It is argued that current thinking with regard to these issues reflects historical domains within which services to children and to adults are located. The challenge to domain thinking is both horizontal and vertical, policy being required to address the horizontal axis by co-ordinating planned approaches to multiple needs across services, and policy being necessary to address the vertical cleavage between children’s and adult services in ways which join up services across the life path; conceptually and practically acknowledging the links between child and adult experiences. • Applications: Such policy developments will inevitably require social work to develop alternative paradigms for understanding the needs of children and adults and designing services to effectively meet these.

Mandated prevention in child welfare: Considerations from a framework shaping ethical inquiry

• Summary: This article outlines a framework for approaching ethical dilemmas arising from the development, evaluation and implementation of child welfare policies. As such, it is relevant to policy-makers, social researchers and social workers. The central tenets of the framework are developed by drawing on ideas from moral philosophy and critical social theory. These ideas are presented as axioms, theorems and corollaries, a format which has been employed in the social sciences to offer a rational justification for a set of claims. • Findings: This process of reasoning leads to four principle axioms that are seen to shape the ethical scrutiny of social policy: 1) problematizing knowledge; 2) utilizing structured forms of inquiry to enhance understanding; 3) engendering enabling communication with those affected by the ethical concern; and 4) enhancing self-awareness. • Applications: The four axioms are then applied, by way of example, to the current and contentious, ‘third way’ policy of mandated prevention in child welfare, where the aim is to obviate deleterious outcomes in later life. It is argued that the framework can be applied beyond this specific concern to other pressing, ethical challenges in child welfare.

Possible futures for social work with children and families in Australia, the United Kingdom and the United States

There has been considerable interest in recent years in comparing the operation of social work services for children and families internationally, particularly between Australia, the United Kingdom and the United States. Reviewing the respective policy environments and drawing on recent research experience in these three nations, the author speculates as to how such services may be placed to respond to a converging agenda to tackle the high social and economic costs of social exclusion. It is argued that a conspiracy of circumstances have led child and family social work away from its more general child welfare objectives of the past and have created consolidation of functions in relation to child-protection work. This has left services ill-prepared to play a central role within a new and resurgent child welfare agenda. If child-protection systems are to successfully metamorphose to encompass child welfare ideals, they will need to reconfigure to help shape their own future. This future will be concerned with the identification of, and service provision to, marginalised populations predicted to create high lifetime social and economic costs for society—the alternative being a default to the reductionist position of child-protection agencies largely concerned with the management of “child abuse”.

The fourteenth national conference on child abuse & neglect: gateways to prevention, 31 March–5 April 2003, St Louis, Missouri, USA

The Office on Child Abuse and Neglect of the Children’s Bureau of the US Department of Health and Human Services has organised and run this major conference since 1976 as an opportunity for professionals in the fields of both practice and research to come together to meet and exchange information about the identification, prevention and treatment of child abuse and neglect. In total 1600 delegates from North America (and two from Northern Ireland!) attended this year’s event, which had as its theme ‘Gateways to Prevention’ in recognition that prevention remains the best, but also often the most elusive, option for the protection of children. As a core objective within the current US policy agenda, the conference was organised to coincide with President Bush declaring April 2003 as ‘Child Abuse Prevention Month’, the 20th anniversary of this initiative. The danger in attending a national conference in a far away place is that the challenges facing the locals and the possible solutions being considered will have little or no resonance for child protection in one’s own locality. Therefore it was both heartening and depressing to realise that the North American child protection systems are struggling with similar problems to those of the United Kingdom, and that the solutions being considered and adopted to deal with these issues would not look out of place locally. The United States is struggling with trying to develop supportive services for families while not losing track of the children who need protection; the quality of out-of-home care is variable and often poor; the recruitment and retention of skilled and competent staff is problematic, and there is a need to improve the effectiveness of interventions. These issues have combined with a political call to make practice evidence based to create a higher public profile of the needs children and their families. The aim of this brief paper is to highlight some of the key research and issues shared at the conference and to advocate a wider perspective in seeking potential new ways of working with what are universal problems among the nations of the industrialised West.